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Renal Cortical Necrosis
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- Defined as necrosis of portions of the renal medulla
- Clinical features: when bilateral and diffuse, it may be associated with acute renal failure, fever, chills, flank pain, and hematuria; when insidious in onset, it may manifest as a concentrating defect or as progressive renal failure; typically affects adults although infants may occasionally develop a similar process (renal medullary necrosis) -- usually < 1 month old and have a history of perinatal asphyxia or a severe infantile disease associated with vascular collapse and dehydration (such as gastroenteritis).
- May be associated with any number of disease entities, but the most common one is diabetes mellitus; also: analgesic abuse.
- Pathogenesis is actually ischemic, and is related to marginal blood supply (which explains the prevalence in patients with underlying vascular disorders such as diabetics)
- Gross features: necrosis of renal papillae/ medullary portion
- Histologic features:
- necrosis usually does not involve the entire medulla
- from a vascular standpoint, the papillary tip is the most vulnerable, so it is the first to go
- because the necrosis is induced by ischemia, it typically has a coagulative appearance.
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